Provider Demographics
NPI:1003014820
Name:FRATTINGER, STACEY RUTH (RD)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:RUTH
Last Name:FRATTINGER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10415 DOUBLE R BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8905
Mailing Address - Country:US
Mailing Address - Phone:775-829-2277
Mailing Address - Fax:775-829-2365
Practice Address - Street 1:10415 DOUBLE R BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8905
Practice Address - Country:US
Practice Address - Phone:775-829-2277
Practice Address - Fax:775-829-2365
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV104364Medicare UPIN